Studies of patients with urethral catheters in place for short periods (less than 30 days) have demonstrated the importance of preventing bacteriuria. However, our previous studies at two of the nursing homes included in this proposal suggested that this goal is overly simplistic for patients catheterized for longer periods; these patients are almost always bacteriuric. Our major conclusions from these studies were two: 1) that chronic urethral catheters should be avoided it possible, and 2) if used, the major thrust of medical care should be towards prevention of complications of the universal bacteriuria. We propose to study aged nursing home patients with apparent need for chronic urinary drainage assistance. A five-year study in several nursing homes will measure the incidence of acute morbidity (fever, bacteremia, local infections) and chronic morbidity (renal dysfunction, urinary stones, and death) in four groups of patients: 1) with urethral catheters, 2) with condom catheters, 3) non-catheterized, and 4) those from whom urethral catheters have been removed following a simple urologic evaluation. In a more intensive investigation at the nursing homes previously studied, we propose to identify the one year incidence of acute complications as related to bacteriuric factors and catheter obstructions. In patients with urethral catheters in these two institutions, we will then conduct three year-long controlled trials of interventions which, based upon our studies and others, offer promise of reducing acute morbidity. These interventions will be 1) thrice weekly catheter irrigations, 2) short course antibiotic use at the time of catheter obstruction and/or replacement, and 3) intermittent catheterization. In order to extrapolate the morbidity of chronic urinary catheters to general nursing home populations, we will survey a random sample of Maryland nursing homes for prevalence of and indications for urinary drainage devices. The overall intention of the project is to identify the morbidity associated with urethral and condom catheters and to attempt to reduce this morbidity using selective interventions, including the removal of the urethral catheter itself. These findings could lead to development of guidelines for the use of urinary catheters in nursing home patients.